If you’re a football fan, you’re probably used to seeing ads for erectile dysfunction drugs. And arthritis drugs. And psoriasis drugs. Televised NFL games are magnets for prescription drug ads.

So it’s curious that pharma companies tend not to play on the biggest stage of all — the Super Bowl.

There was just one pharma ad in last year’s Super Bowl, and so far, none have been announced for this year. Here are three reasons why:

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The glare of the spotlight can be harsh

In the lighthearted atmosphere of the Super Bowl, it’s an uphill battle to produce a successful ad about a serious health condition. The fact that drug makers are required to rattle off a long list of potential side effects doesn’t help, either.

Valeant Pharmaceuticals made a play for Super Bowl glory last year with a quirky spot to promote its prescription antifungal cream Jublia. In the animated ad, a helmet-clad big toe raced across a football field to “tackle toenail fungus.” It fell flat, drawing scorn on social media. “Nothing goes with Super Bowl chili con queso dip like a toenail fungus commercial,” one viewer wrote.

By contrast, “nobody is scrutinizing the advertising that’s running on a typical Sunday afternoon football game,” said Timothy Calkins, a marketing professor at Northwestern University’s Kellogg School of Management.

It’s expensive

Drug companies have plenty of cash to spend on advertising, but the price for a single Super Bowl ad — now up to $5 million for a 30-second spot — is likely to prompt even the most wealthy companies to consider cheaper alternatives to reach sports fans.

Among the alternatives: Regular season NFL games. In each of the last two seasons, viewers watching these games on network TV saw ads promoting an average of 13 different prescription drugs, according to the research firm Kantar Media. Oftentimes, they saw a handful of drug ads during a single game.

The audience is too diluted

The viewership for regular season football games tends to skew older and male — the target audience for a drug for, say, erectile dysfunction. In fact, Eli Lilly’s ED drug Cialis was the most commonly advertised medication during these games, according to Kantar Media.

But the Super Bowl brings out the whole family.

“You’re talking millions and millions of people, and you may only get a fraction of [the audience] you want,” said Chuck Thompson, executive vice president of the Video Advertising Bureau, a trade group for TV companies.